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Admission Application Form

This document is an application form for admission to the Pro PCTech I.T Institute's diploma programs in Computer Application, Information Technology, and Advanced Diploma in Computer Application. The form requests information such as the applicant's name, date of birth, gender, address, academic qualifications, nationality, and a declaration signed by the applicant stating that the information provided is true. The form also provides instructions for documents to attach including a photograph, nationality certificate, resident certificate, and marksheets.

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Satyajit Dhar
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185 views2 pages

Admission Application Form

This document is an application form for admission to the Pro PCTech I.T Institute's diploma programs in Computer Application, Information Technology, and Advanced Diploma in Computer Application. The form requests information such as the applicant's name, date of birth, gender, address, academic qualifications, nationality, and a declaration signed by the applicant stating that the information provided is true. The form also provides instructions for documents to attach including a photograph, nationality certificate, resident certificate, and marksheets.

Uploaded by

Satyajit Dhar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Pro PCTech I.

T Institute
An academy of computIng systology & scIence

Regd. Under Govt. Of Tripura, Act-


APPLICATION FORM FOR ADMISSION IN
1860,Registration No.160042101129,Govt. Of
India. Head Office: Kailashahar,Unakoti DIPLOMA IN COMPUTER APPLICATION AND
Tripura, India-799277 CERTIFICATE IN INFORMATION TECHNOLOGY

Please Give Tick Mark / Fill Up In The Appropriate Field…………….

1. Programme Applied For : DCA CIT ADCA

2. Name Of Applicant : _____________________________________________________________

3. Father’s Name : _____________________________________________________________

4. Mother’s Name : _____________________________________________________________

5. Name of Guardian if Orphan : _____________________________________________________________

6. Date Of Birth : MM DD YYYY

7. Gender : M F

8. Mobile No. : + 91

9. Telephone No. : STD____________________ Land Phone No.____________________________________

10. Email Address : _____________________________________________________________

11. Residence Permanent Address : Street address_________________________________________Vill/Town______________

_________________P.O_________________________Pin:______________________

District___________________State____________________Country___________________

12. Residence Present Address : Street address_________________________________________Vill/Town______________

_________________P.O_________________________Pin:______________________

District___________________State____________________Country___________________

13. Academic Qualification : _____________________________________________________________


14. Whether Appeared For Madhyamik: YES NO If yes than total marks obtained___________

Out of_____________Percentage of marks___________%

15. Adhaar Registration Number : ____________________________________________________________

16. Nationality : ___________________________

17. Whether Resident Of Tripura : YES NO

18. Religion : ___________________________

Student Declaration

I,Sri/Smt_____________________________________S/O,D/O______________________________________P.O____________
____________________________P/S_________________________________of District__________________________, do
hereby declare and affirm that the particulars given in the application form are true to the best of my knowledge and belief and in
case any of the particulars furnished is found to be false at any subsequent state, my admission can be cancelled as or decision
made by the authority of the concerned institution. I shall also be liable to other actions which the institution authority may take
against me.

Date:______/______/___________

Place: Signature of the applicant

Seal And Signauture Of The Head Of The


Institution
(For Office Use Only)

Please enclose the following particulars attached with the application form:-

1. One recent colored stamp size photograph of the applicant.


2. One Xerox copy of Nationality Certificate duly attested by self.
3. One Xerox copy of Permanent Resident Certificate duly attested by self.
4. One Xerox copy of Student Madhyamik Examination Marksheet if applied for DCA & ADCA or else Xerox copy of 8th standard marksheet for CIT
duly attested by self.
5. One Xerox copy of Student Adhaar Card duly attested by self.

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